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Amnestic aphasia in MELAS can be epileptogenic

      Referring to the article by Sakata et al. we disagree with the diagnosis “thalamic aphasia” [
      • Sakata Y.
      • Nakamura T.
      • Ichinose F.
      • Matsuo M.
      Thalamic aphasia associated with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes: a case report.
      ]. Since thalamic lesions can be associated with status epilepticus (SE) [
      • Parreira S.
      • Abreu L.
      • Franco A.
      • Bentes C.
      • Peralta A.R.
      Non-convulsive status epilepticus induced by acute thalamic lesions: a report of three cases.
      ], it is crucial that SE has been ruled out
      Abbreviations CK: creatine-kinase; EEG: electroencephalography; FLAIR: fluid attenuated inversion recovery; PLEDS: periodic lateralised epileptiform discharges; PWI: perfusion-wieghted imaging; SE: status epilepticus; SLE: stroke-like episode; SLL: stroke-like lesion.
      2Abbreviations CK: creatine-kinase; EEG: electroencephalography; FLAIR: fluid attenuated inversion recovery; PLEDS: periodic lateralised epileptiform discharges; PWI: perfusion-wieghted imaging; SE: status epilepticus; SLE: stroke-like episode; SLL: stroke-like lesion.
      . Therefore, we should know if creatine-kinase (CK) was elevated to 5883 U/l due to myopathy, the stroke-like lesion (SLL), cardiomyopathy, or a SE. Because periodic lateralised epileptiform discharges (PLEDs) can be the manifestation of a non-convulsive/minimal convulsive SE [
      • Wang Z.
      • Chu C.
      • Jing C.
      • Zheng X.
      • Lin W.
      Non-convulsive status epileptics presenting with periodic lateralized epileptiform discharges and coma after cerebral hemorrhage: a case report.
      ], we should know if a SE was recorded on electroencephalography (EEG) on hospital-day 8 and why midazolam was administered. Since headaches were interpreted as epileptogenic, we should know whether the patient had seizures or epileptiform discharges on EEG. A structural lesion is not a prerequisite for amnestic aphasia since SE may explain aphasia. It could be also a post-ictal phenomenon. Was a third EEG free of epileptiform discharges? Was the patient discharged with an anti-seizure medication?

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      References

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        • Nakamura T.
        • Ichinose F.
        • Matsuo M.
        Thalamic aphasia associated with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes: a case report.
        Brain Dev. 2022; 44: 583-587
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        • Abreu L.
        • Franco A.
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        Non-convulsive status epilepticus induced by acute thalamic lesions: a report of three cases.
        Seizure. 2021; 89: 1-4
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        Non-convulsive status epileptics presenting with periodic lateralized epileptiform discharges and coma after cerebral hemorrhage: a case report.
        Neurol India. 2021; 69: 733-736
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